News in brief
Government to mandate NHS digitisation: The government wants to mandate NHS England to support the health service to go digital by 2018, reported eHealth Insider. It also plans on extending the Friends and Family Test to GP practices. As part of the celebration of the NHS’ 65th anniversary, the government has launched a consultation on a ‘refresh’ of its mandate to NHS England, which was announced in November last year. The consultation reflects developments such as the publication of the Francis Enquiry and health secretary Jeremy Hunt’s challenge to go paperless by 2018. “The government wants to move to paperless referrals in the NHS so that patients and carers can easily book appointments in primary and secondary care and for people to benefit from electronic prescribing in primary and secondary care,” says the consultation. “The government therefore proposes to update the existing technology objective to challenge NHS England to support the NHS to go digital by 2018.”
NHS England outlines importance of technology in improving health service: A report from NHS England says IT has a role to play in reshaping the health service for the better, reported Computer World UK. The “NHS belongs to the people – a call to action” report says the major health authorities in England are working together “alongside patients, the public and other stakeholders to improve standards, outcomes and value”. The report says the “digital revolution can give patients control over their own care”. It says patients should have the same level of access, information and control over their healthcare matters as they do in the rest of their lives. The NHS must learn from the way online services help people to take control over other important parts of their lives, whether financial or social, such as online banking or travel services. “First introduced to the UK in 1998, now more than 55% of internet users use online banking services,” says the report. A comparable model in health would offer online access to individual medical records, online test results and appointment booking, and email consultations with individual clinicians.
NHS ‘heading for £30bn funding gap’: The NHS in England needs to take urgent decisions about reorganising hospital and GP care to avoid a growing funding gap, according to its leaders, reported the BBC. In a report, NHS England warns that by 2020-21 the gap between the budget and rising costs could reach £30bn. The organisation’s chief executive, Sir David Nicholson, said services needed to be concentrated in fewer hospitals, otherwise the pressures could lead to another tragedy on the scale of the failings at Stafford Hospital. Nicholson told BBC Radio 4’s Today programme: “We need to make sure that the way in which services are organised is in the best way for patients.” He said concentrating specialists services was key – citing stroke services in London where 31 hospitals used to provide stroke care, with the city having some of the worst outcomes for patients. Services are now concentrated in eight hospitals – and outcomes are some of the best in Europe. Sir David also said preventative care and improved services for people in the community were crucial – and said there needed to be a drive to make the NHS more efficient and productive. He said it was “really very urgent” that decisions were made. In response to the report Tim Kelsey, director of NHS England told eHealth Insider that IT can fill the £30 billion gap.
NHS must be tougher on private providers, say MPs: The NHS needs to be much more ‘commercially shrewd’ in dealing with big contractors, a scathing report into Serco’s ‘substandard’ management of the out-of-hours service in Cornwall has found, reported GP Online. A 52-page report by the House of Commons Public Accounts Committee (PAC) published this week said whistleblowers were responsible for exposing staff shortages at the service last year. MPs said Serco staff were bullied after they revealed that the company ‘lied about its performance data’ on 252 occasions. The PAC report said NHS Cornwall and Isles of Scilly was ‘deeply ineffective’ and ‘made some bonus payments despite the fact that Serco’s performance was falling well short of what was required’. Even when it knew that Serco had falsified performance data, the primary care trust (PCT) did not fine the contractor or terminate the contract, the report said. Committee chairwoman Margaret Hodge (Lab, Barking) said: “It is disgraceful that the public had to rely on whistleblowers to find out that the out-of-hours GP service in Cornwall, provided by private contractor Serco, was short-staffed and substandard, and that service data was being manipulated, making the company’s performance look better than it was.”
The cancer diagnosis letter found in a car park, voicemails to the wrong person and a gate-crashed consultation: Hospital data breaches up 20% in a year: Hospitals have seen the number of confidentiality breaches and losses of patient data rise by a fifth over the past year, with thousands of such incidents reported, a Pulse investigation reveals. Figures obtained under the Freedom of Information Act from 55 hospital trusts who were able to provide comparable year-on-year statistics show that the number of data breaches rose from 2,337 in 2011/12 to 2,805 in 2012/13 – a 20% year-on-year increase. Common examples included patients being given a different patient’s details in error, patient information being given to a relative without their permission, voicemails left to the wrong person, letters left in public meeting rooms and letters sent to patients’ previous GPs. The investigation also found that there was a 15% increase in data and confidentiality breaches between 2010/11 and 2011/12. In total, the 55 trusts recorded 7,138 incidents over the last three years, results the General Practitioners Committee said could cause patients to ‘lose faith in the NHS’ and could undermine public trust in the move towards a ‘paperless NHS’ by 2018.
NHS England to take control of investment spending: NHS England is drawing up plans to centralise control of spending on estates and information technology in the health service, including proposals to sign off spending by bodies over which it has no formal power. A document seen by Health Service Journal (subscription required) (HSJ) says plans to establish a central “project appraisal unit” are at an advanced stage. The unit’s job will be to evaluate business cases for spending on infrastructure and assets by NHS England, clinical commissioning groups (CCGs), NHS Property Services Ltd, Community Health Partnerships, and even NHS providers. The unit will be led by Peter Brazel, former head of strategic investment at NHS London. According to the document, which was produced by NHS England to accompany a presentation, the unit will focus on “both capital and revenue” business case proposals for: healthcare facilities and clinical equipment, administrative facilities and non-clinical equipment and both clinical and non-clinical information systems. It effectively means that NHS England plans to oversee all investments made by NHS Property Services. HSJ understands the separation of capital funding in this way is intended to ensure NHS Property Services does not leave NHS England or CCGs unable to fund service change by over-spending on maintenance.
Government ‘likely to need legislation’ to change NHS merger rules: The government is likely to have to legislate if it wants to change the regulation of NHS provider mergers, Health Service Journal (subscription required) has been told. Health secretary Jeremy Hunt said this week that he had concerns about the roles of the Office of Fair Trading (OFT) and the Competition Commission in checking mergers. The 2012 Health Act gave the OFT, the national general competition watchdog, explicit responsibility for mergers between foundation trusts. In March the OFT confirmed it would also have responsibility for assessing any merger involving a foundation trust (FT), including mergers between FTs and NHS trusts. If the OFT decides a merger might cause a substantial lessening of competition, and this would outweigh any patient benefits, it will refer it to the commission. Hunt told a commons health committee hearing last week: “It is a concern to me… I want to make sure that they properly consider the benefits [of mergers] and also that it doesn’t take too long.” Pressed on whether he would consider changing the law he said: “If we thought there was a serious problem in terms of the structures… then we would consider it, yes.”
CCGs to make £30bn of savings: NHS England has announced that clinical commissioning groups (CCGs) will be asked to make further savings of £30bn in addition to the £20bn Quality Innovation Productivity and Prevention savings they are already having to make, reported Pulse. In a much-anticipated document, launched today under the banner ‘A Call to Action’ (subscription required), NHS England calls on CCGs to formulate 3-5 year plans to help solve a funding gap of £30bn by 2020/21. The document says the funding gap must be solved through ‘freeing up NHS services and staff from old style practices and buildings’. The consultation process will focus on producing ‘meaningful views, data and information’ that will help CCGs implement already-announced policies such as shared patient records across services, telehealth, early dementia diagnosis and better management of long-term health conditions. GP leaders have cast doubt on whether the savings can be made through these methods, however. CCGs will be required to meet with charities and patient groups to find ‘local solutions’ to the challenges facing the NHS from issues such as a UK budget freeze, an ageing population and the rise of obesity and people living with long-term health conditions.
NHS’ new IT system ‘not operating as intended’: Spending on information technology to overhaul the NHS has kept within double-digit millions – but only, a report suggests, thanks to overblown cost estimates and inadequate uptake of new systems, reported Contractor UK. In fact, in terms of the Department of Health implementing its new corporate IT system to support its own operations and most of the new arms-length bodies, the National Audit Office (NAO) found a “considerable amount of work remains”. In particular, as of April 1st 2013 the new IT system was not “operating as intended”, evidenced by NHS data for last month showing that only approximately 30% of the expected users were using it. Partly as a result, the NHS’s overhaul has seen only £54m spent on IT to the end of March 2013 – down on the £127m which the department estimated, and down further from the £167m it initially envisioned in December 2011. Aside from the system not having been rolled out, notably to NHS England staff, the NAO uncovered another reason why IT spending appears so low to date. According to its report, the estimates were subject to “uncertainty” for being based on “little reliable information”.
Legacy McKesson trusts pick and choose: Eight of the 26 English trusts running McKesson’s legacy Totalcare and Star patient administration systems (PAS) have chosen to migrate to System C’s Medway PAS, reported eHealth Insider. Many of the trusts have been running the legacy systems since the early 1990s, but their current support contract runs out in March next year. Eight have decided to implement the Medway PAS from System C, now a McKesson company, with some also planning to implement parts of the electronic patient record system. Four trusts have chosen to deploy Cerner’s Millennium EPR, two have chosen to take CSC’s Lorenzo, and two have taken the Silverlink PAS. Cambio, FileTek and Oasis have also won one trust each. The support contract for the legacy McKesson systems was signed in 2006. It enabled 26 trusts in England, 18 of which are in the North, Midlands and East, to keep or deploy their PAS systems until NPfIT systems became available. In 2010, as delays to NPfIT mounted, NHS Connecting for Health extended the contract until March 2014. Some of the 26 trusts have already implemented replacement systems, but as the end of the contract moves closer, there has been another influx of trusts going out to procurement.
Having a named clinician will put additional burdens on general practice: In response to the health secretary’s plans for a named clinician to be responsible for each elderly persons care, the Family Doctor’s Association (FDA) has emphasised the need to free up GP time in order to achieve this, reported Commissioning GP. The FDA, an educational charity which has represented grass roots GPs nationally and locally for over 25 years, has overall welcomed the proposals to improve care for the elderly, but has called for a “reality check” before they are implemented. Dr Michael Taylor, national executive of the FDA said: “Our organisation has long campaigned about the very real benefits of named clinicians and relational continuity of care. The secretary of state however needs a reality check: this plan will place additional burdens on UK general practice which is at breaking point in many areas. “In short, yes Mr health secretary but free us up to deliver.” Health secretary Jeremy Hunt announced last week new initiatives to improve the care of the elderly, and the proposals are now open for public consultation.
Open standards key to integrated care: Open standards are key to achieving the government’s aim of integrated digital care records by 2018, says IHE’s UK chair. Neil Robinson, UK chair of the non-profit organisation dedicated to interoperability in health information technology, told eHealth Insider that as the NHS “moves away from monolithic data structures”, it is essential that the different parts of health and social care services are able to talk to each other. “This is really the essence of putting the patient at the centre of their own care as you can only put the patient at the centre if the information about them is shared and you can only share information if you’re all talking the same language,” he explained. “It’s got to be open standards and that opens the market up to more SME organisations.” Robinson added that smaller businesses would have a particular role in providing options for linking information from the community and voluntary sectors. IHE is holding a free webinar on standards next Tuesday, 16 July, with speakers including Inderjit Singh who works on the Technology Fund initiative at NHS England. The webinar is being supported by NHS England and the Health and Social Care Information Centre
Sir David Nicholson: I am ‘absolutely proud’ of my NHS record: The outgoing chief executive of NHS England denied there has been a lack of accountability in the NHS despite none of the managers who oversaw Stafford hospital, where hundreds of patients may have died needlessly, being sanctioned or punished, reported The Telegraph. Nicholson previously admitted personal failings over Mid Staffs. He oversaw the trust early in the scandal. In recent weeks the NHS has faced fresh scandal over the deaths of babies and mothers at University Hospitals Morecambe Bay NHS Foundation Trust. Sir David has also received heavy criticism over the use of controversial gagging orders in the NHS. Earlier this year, he announced his early retirement after admitting the NHS is still failing patients. Speaking to BBC Radio 4’s Today programme, Sir David flatly denied that he had not been held accountable for mistakes made during his time running the NHS. “I’ve accounted for what I’ve done on numerous occasions,” he said. “There’s hardly a week that goes by where I’m not at a parliamentary committee or talking to somebody explaining the things that I’ve done and the way that I’ve done them. I’m absolutely proud of my record in delivering change and improvements for the NHS.”
NHS England to double media relations team to launch PR fightback: NHS England has pledged to almost double the size of its media relations team to get on the front foot in telling the service’s story, with a focus on digital comms and patient engagement, reported PR Week. Another key part of the NHS, the Trust Development Authority (TDA), is in the process of creating a roster of external comms experts and agencies to similarly boost its media relations firepower. NHS England interim comms head Stephen Webb, said the importance of driving the media agenda on healthcare was illustrated by research pointing to a mismatch between A&E waiting times and media coverage on the issue. “The NHS is really up there as a domestic story at the moment and things are very politicised. Though we need to recognise the fact that there have been performance problems, the continual perception of A&E in crisis creates more political noise and risks preventing wider changes that need to happen.”
St Helens does single sign-on: St Helens and Knowsley Health Informatics Service is implementing Imprivata’s single sign-on across its NHS organisations, reported eHealth Insider. The Health Informatics Service (HIS) has deployed the single sign-on system across 90% of its GP practices and is rolling it out in its two acute hospitals, with community and mental health services to follow. Neil Darvill, director of informatics at the HIS, told eHealth Insider the service is also looking at deploying OneSign on mobile devices. “We’ve got some more roll-out to do in hospitals,” he said. “We also have a very clear appetite to get it working on mobile devices such as tablets. We haven’t rolled it out in community and mental health yet. Sometimes the mobile working can have some issues, but it’s in the work plan to solve that.” Darvill said that the most important benefit was the ‘kiosk’ like function, which means that clinicians need a smart card to access the computer. This means there is no danger of a previous user leaving a device ‘locked’ to them.
Opinion
How clinical commissioning groups are handling new responsibilities
This week, Dr Steve Kell, chair of Bassetlaw CCG and co-chair of NHS Clinical Commissioners Leadership Group, tells the Guardian Healthcare Network how the first 100 days since the birth of CCGs has been “one of the most exciting, frustrating and meaningful” periods of his career.
Kell cites partnerships and understanding the needs of local patients as integral to a high performing CCG: “As a CCG we have a strong sense of responsibility for our local population. Patient engagement is central to this. We have well established practice patient groups and groups within the CCG, and this role is led by our new lay member who has worked hard to ensure we have a new, meaningful approach. We have developed a series of summits with patients, carers and providers including extremely successful dementia and learning disability events.
As CCGs continue to get to grips with the new system, Kell argues that more information is required to accurately analyse each local population’s health and social requirements but is confident authorisation of CCGs will prove worthwhile: “We operate as just one part of a complex commissioning system. We need to ensure we are active partners alongside public health, regulators and NHS England, and that our clinical involvement and patient engagement lead to better outcomes. After 100 days I’m optimistic. Clinical commissioning is delivering. The NHS needs it to succeed.”
Are electronic patient records the next big thing?
In the Guardian Healthcare Network this week The Patient from Hell, Dick Vinegar wonders whether patient records should be kept by GPs instead of by hospitals.
“Electronic patient records (EPR) have had a bad press since the multiple disasters of the national plan for IT. In fact, hospitals, like Berkshire and Morecambe Bay, are still in trouble in their attempts to implement EPR. But, despite all that, NHS England has decided that EPR is the next big thing, in a document called Safer Hospitals, Safer Wards. Someone as old as I am can only sigh, “Oh no, not again. The only difference from the past is that NHS England does not call it an electronic patient record any longer, but an integrated digital care record (IDCR). On principle, I have to object to this name, because it omits the word patient. I don’t fancy the word integrated much, either.
“No patients got involved, as they never do in the design of NHS IT systems. Safer Hospitals, Safer Wards does put more emphasis on the patient, but not much. So, again, it is my duty to put a patient’s view as forcefully as I can. It began four years ago, when I was being treated for cancer at one hospital and for incipient diabetes at another five miles away. Neither set of doctors showed any interest in what the other hospital was doing. Even if they wanted to, they could not have done so electronically, as their systems were incompatible. Fortunately for them, I was still compos mentis enough to stop them giving me redundant or clashing treatments.
“To me, the patient, the most important thing about a record is that it is easily read by the many people who treat me: GPs, hospital doctors, nurses, physiotherapists, pharmacists and social workers. This implies that all these people know where to find the record. I suggest that the more logical home for a master patient record, with interoperative open-source hooks into hospital systems, would be the GP record. Family doctors are used to keeping their records up to date. The GP record is for life, whereas hospital records handle only episodes of a patient’s treatment.”
Why do people find it so hard to speak out in the interests of patients?
This week Bev Fitzsimons, programme manager for The Point of Care, writes a blog for The King’s Fund. Fitzsimons asks why, if healthcare staff have a desire to make a difference for patients and service users, do they find it so hard to speak up for them when they see care that does not meet satisfactory standards?
“The Francis Inquiry report highlighted three key characteristics of health care culture: openness, transparency and candour; these are desirable, but can be hard to achieve. There are a number of reasons for staff in all professions and at all levels to stay silent when they see practice that falls short of acceptable standards. The structures and processes within an organisation can be hierarchical and defensive, which mitigates against speaking up or exposes those who do to risk; there can also be social reasons – challenging friends and colleagues can often be difficult. Sometimes staff keep quiet because they wonder: if I am saying this about my colleague’s practice, what does it mean for my own?
“In any workplace there are issues that are not discussed. In health care, these can have an adverse effect on patients. Research, for example that by Maxfield D et al on the seven crucial conversations for health care, shows that a high proportion of health care professionals say they have worked with people who take shortcuts or show disrespect in the way they go about their work. There is also evidence that people are particularly likely to take shortcuts when they are tired and under pressure. So how can these issues be dealt with?
“Organisations must support and celebrate those who are willing to speak up and develop structures and processes to support this, and their leaders must model this behaviour themselves.
“There cannot be an inspector at the end of every bed – self-improving organisations will be sustainable only when every member of staff feels able to express their care and concern for patients and colleagues and confident that they will be listened to and heard.”
No jam tomorrow for the NHS
In Health Service Journal (subscription required) this week, Crispin Dowler asks why people devote so much time when they are almost certain to fail, citing South London Healthcare becoming the first NHS trust subjected to the service’s “unsustainable providers regime” as an example.
“As we know, South London’s “special administrator”, Matthew Kershaw, concluded its financial problems were so profound they could not be solved within the trust, leading to controversial reconfiguration recommendations and (last week) a judicial review.
“However, he also concluded there was much the trust could have done to improve its finances. His report said South London was less efficient than 17 of the 18 trusts in its peer group. He recommended a cost savings programme of around £75m over three years, plus reorganisation of its estate and land disposals.”
Dowler continues by stating that despite all these measures “…if it had done all those things the trust would still have been in the red.”
At the Healthcare Financial Management Association conference last week, Monitor chief executive David Bennett addressed the financial problems facing the NHS as a whole.
“On its best case scenario, the conference heard, Monitor reckons the NHS could get £18bn from assorted savings, plus around £7.5bn from land and building sales. This totals £25.5bn − £2.5bn shy of Monitor’s lower estimate of the funding gap.
“When we do all these things − this is pretty well everything we can think of, within reason, that the sector might do − it doesn’t quite close that gap,” Mr Bennett told the conference.
Highland Marketing blog
In this week’s blog, Chris Marsom asks how the NHS is going to address the funding gap.
